(LML) Nerve Decompression in Leprosy

 

Leprosy Mailing List – November 28,  2016

Ref.:    (LML) Nerve Decompression in Leprosy

From:  Marcos Virmond, Bauru, Brazil

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 Dear Pieter

 

Let me comment the message by dynamic Dr. Gajete from the Philippines and the very fine reply by Dr. Theuvenet, LML November 26, 2016.

The last relevant incursion of WHO in the field of leprosy surgery (including neve decompression) was the publication of an important book by Dr. H. Srinivasan and Dr. Dinkar D. Palande in 1996 (!) (Essential surgery in leprosy: techniques for district hospitals – WHO/LEP/96.2). I am not sure whether this book is still available or not.

Unfortunately, nerve decompression is an essential procedure that is constantly neglected in leprosy services. The reprint of WHO’s book would be a good contribution as well as any move to offer training to general surgeons willingly to learn how to perform a neurolysis. To some extend it is a simple procedure but requires adequate training, use of magnifying glasses and fine surgical instruments – besides proper indication.

Yes, it is time to put nerve surgery again on the agenda!

With many regards

 

Marcos

 

M. Virmond MD PhD

ILSL – head

Bauru - Brazil

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LML - S Deepak, B Naafs, S Noto and P Schreuder

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(LML) Nerve Decompression in Leprosy

Leprosy Mailing List – November 26,  2016

Ref.:    (LML) Nerve Decompression in Leprosy

From:  Francisca Gayete, Philippines and Wim Theuvenet, the Netherlands

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Dear Pieter,

 

 

There is an issue which concerns the National Leprosy Control Program partcularly,in addressing our goal towards Zero Disability.

 

Is there any Training Program offered/sponsored  by GLP/WHO for  Surgeons working in Sanitaria/Partner Hospital for Reconstructive Surgery/Neural surgery? Most General Surgeons including those at the Philippine Orthopedic Center are hesitant to perform the simplest epineural decompression.

 

Our warmest regards,

 

 

Francisca Gayete

 

 

Reaction by Wim Theuvenet:

 

 

Dear Cess,

 

Zero Disability is the second greatest ambition (after the eradication of leprosy) of every committed leprologist and I am so happy that Dr Ben Naafs is putting it on the agenda again!

 

Personally I feel that apart from the earlier detection of leprosy, we can improve on;

 

1. The earliest recognition of (often silent) neuritis; 

 

2. The more successful treatment of neuritis, and amongst this:

 

3. The surgical decompression of nerves, especially when the other treatments have failed and the risk of permanent nerve function loss becomes real.

 

Answering your question: I am not aware of any official GLP/WHO sponsored courses in Reconstructive Surgery in leprosy. However, there are quite a few very experienced surgeons (I know a number of excellent colleagues in India, Nepal and Brazil) working in this field and trust that they can provide adequate training either at their leprosy hospitals or possibly at your institute

 

Personally, I have been involved in conducting these Surgical Courses in Leprosy Surgery (incl. POID) for the last 20 years, in 14 countries around the globe; mostly coordinated through The Leprosy Mission International (TLMI) and the Netherlands Leprosy Relief (NLR). There is a 3-level training format for this.

 

When you, together with the colleagues at the Philippine Orthopedic Center, see a clear need for assistance by getting this training, you are welcome to “Ring the Bell”!

 

 

With best regards,

 

 

Wim

 

 

Willem Theuvenet, M.D., Ph.D

Plastic, Reconstructive and Hand surgeon (FESSH)

Consultant for TLMI and NLR

Mail: WimTheuvenet1@gmail.com

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LML - S Deepak, B Naafs, S Noto and P Schreuder

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Contact: Dr Pieter Schreuder << editorlml@gmail.com

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(LML) I was dreaming

 

Leprosy Mailing List – November 18,  2016

Ref.:    (LML)  I was dreaming

From:  Ben Naafs, Munnekeburen, the Netherlands

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Dear LML reader,

We received a question for Ben Naafs from Jim Wilton, NH, USA:

“Ben, at the known areas of construction where the primary damage occurs we perform epineural decompressions. We have had excellent surgical results working in South America over the past 15 years seeing results in increasing motor power, decreasing or eliminating peripheral nerve pain, and restoring function to arms and legs.”

Reaction Dr Naafs:

“Thank you for your comments.

I agree with you. Nerve surgery, epineural decompression, is a sensible additive to immune-decompression and MDT.  But to think in sequence: first diagnose, then start antibacterial treatment. Then try to work anti-inflammatory and immunosuppressive. Only when the nerve is still compressed and deteriorate a month to 3 month after initiating strong (prednisone) anti-inflammatory therapy, than a nerve decompression should be done. In my theory that is also needed. In my experience too. But surgery should be an addition and not the primary treatment.

What I described, is what will happen untreated. Prednisolone and surgery will take away the compression. But what about MAC and LAM particular in MB that can be present a long time, even under proper antibacterial treatment?”

Ben Naafs

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LML - S Deepak, B Naafs, S Noto and P Schreuder

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(LML) Erythematous itchy rash and Dapsone hypersensitivity

Leprosy Mailing List – November 17,  2016

Ref.:    (LML) Erythematous itchy rash and Dapsone hypersensitivity

From:  Arry Pongtiku, Irian Jaya, Indonesia

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Dear Pieter,

Thank you for sharing about erythematous itchy rash from dr Nepal Nepali and comments from dr Ben Naafs. I would say that I have been working as leprosy adviser in Papua and West Papua for 10 years. Those places have the highest incidence of DDS allergy, Dapsone hypersensitivity in Indonesia. I have seen many cases. Dapsone hypersensitivity is a very important topic in our teaching and on the job training; if diagnosed late can be fatal. We have helped many patients as such.

 

To diagnose of Dapsone hypersensitivity, there are some practical things:

-History of taking MDT for fist to second blister packs

-Some clinical signs as follows:

1. Symptoms of mild (early)
- The skin feels dry
- Itchy Skin
- Skin feels hot burning
- Arise rashes
- Headache
- Watery eyes
2. Severe symptoms usually appear after 24-48 hours after taking Dapsone or after the early symptoms arise.
 - Lips / thick face
- Embossed red spots that itch and heat
- Fever even to high heat
- Dry cough, sometimes accompanied by shortness of breath
- Flaky skin (dermatitis exfoliative), sometimes accompanied by sores on the lips and in the  mouth
- The enlargement of the gland
- The eye (conjunctiva) to yellow

 

In such cases stop MDT immediately if DDS allergy happened more details in attachment. Give immediately give prednisolone and tapering off not in hurry (please kindly find in attachment)

Any drug contains: sulfone such as Trisulfa, Fansidar (Trimetropin Pyrementamin/anti malaria), Cotrimoxasole not allowed for people who have history of allergy DDS

* if we use only Rifampicin and lamprene for DDS allergy sometimes relapse happened

I have seen in August 2016, there was an AIDS patient who received Cotrimoxazole, the clinical appearance was like Dapsone hypersensitivity of leprosy - learning from leprosy to AIDS

Thank you very much, May God bless you
salam,

 

Arry Pongtiku

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LML - S Deepak, B Naafs, S Noto and P Schreuder

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(LML) UK red squirrels are carrying leprosy and have been for decades

Leprosy Mailing List – November 17,  2016

Ref.: (LML)   UK red squirrels are carrying leprosy and have been for decades

From:  New Scientist

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Dear  LML readers,

 

An interesting article from the New Scientist, November 10, 2016.

 

Best wishes,

 

Pieter AM Schreuder

Editor LML

 

By New Scientist staff and Press Association

A study of 110 dead red squirrels from around the UK and Ireland has found that the animals carry several strains of leprosy.

Red squirrels in Scotland, Ireland and the Isle of Wight were found to be carrying Mycobacterium lepromatosis, a bacterial strain that is closely related to a virulent form of human leprosy endemic in Mexico and the Caribbean. Animals on Brownsea Island in Poole harbour carried a different type, Mycobacterium leprae, which is known to have affected people living in southern England over 700 years ago.

The chances of catching the disease from a squirrel are extremely low, and researchers have urged people living close to the animals not to panic. Instead, the finding is more of a concern for those trying to conserve the animals, which are already threatened by squirrelpox and habitat loss.

“We need to understand how and why the disease is acquired and transmitted among red squirrels so that we can better manage this iconic species,” says Anna Meredith, at the University of Edinburgh.

Human strain

Not all the infected squirrels were displaying symptoms. Those that did showed signs of swelling and hair loss from the ears, muzzle and feet.

In humans, leprosy causes nerve and muscle damage which can lead to deformity, disability and blindness if left untreated. However, most healthy people are naturally immune to leprosy and are unlikely to be affected if they are exposed to the bacteria.

The strain carried by the Brownsea Island squirrels was particularly surprising, bearing a similarity to a type of leprosy that was previously found in the 730-year-old skeleton of a leprosy victim buried in Winchester, just 43 miles away.

The discovery of this medieval leprosy strain in the Brownsea Island so long after it was eliminated from humans was completely unexpected, says team-member Stewart Cole, at the Ecole Polytechnique Federale de Lausanne in Switzerland. “This has never been observed before.”

There are currently around 250 red squirrels on Brownsea Island. Of the 25 dead squirrels the team tested, every one was infected with this leprosy strain.

The last recorded case of indigenous leprosy contracted in the UK dates back to 1798.

Carried for centuries

The team’s findings suggests that the Brownsea squirrels may have been affected by leprosy for centuries.

“Brownsea’s wild red squirrel population has been living with leprosy for at least four decades,” says Angela Cott, National Trust general manager for Brownsea Island. “By working with the University of Edinburgh and Dorset Wildlife Trust, we hope to understand how best to look after Brownsea’s wild red squirrels.”

Fewer than 140,000 red squirrels remain in the UK, and the animals may be extinct in Britain within the next 10 years.

 

References:

-       Avanzi C, Del-Pozo J, Benjak A, Stevenson K, Simpson VR, Busso P, McLuckie J, Loiseau C, Lawton C, Schoening J, Shaw DJ, Piton J, Vera-Cabrera L, Velarde-Felix JS, McDermott F, Gordon SV, Cole ST, Meredith AL. Red squirrels in the BritishIsles are infected with leprosy bacilli. Science. 2016 Nov 11;354(6313):744-747. PubMed PMID: 27846605.

 

-       Stinear TP, Brosch R. Leprosy in red squirrels. Science. 2016 Nov 11;354(6313):702-703. PubMed PMID: 27846589.

 

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LML - S Deepak, B Naafs, S Noto and P Schreuder

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(LML) I was dreaming

Leprosy Mailing List – November 16,  2016

Ref.:    (LML)  I was dreaming

From:  Ben Naafs, Munnekeburen, the Netherlands

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Dear Pieter,

 

I was dreaming, may be half a sleep, last night, trying to understand nerve damage in leprosy.

 

A person is infected by M.leprae. Thereafter he will have bacilli alive, or dead and decaying, circulating in his blood. These antigens will be exposed to the innate and adaptive immune system. Most of the antigens will be opsonised by macrophages. He may develop or has already developed a more or less effective immune reaction depending on his genetic constitution, the place of entry of the mycobacteria and earlier contact with other bacteria or antigens relevant for the immune response to M.leprae.

 

The nerves of the person are exposed to micro traumata being stretched by bending joints (elbow, wrist, knee, ankle) or other traumata (Weddell). The vasculature in the traumatised area will develop receptors for cleaning and repairing cells, among them the bacilli and antigen containing macrophages (Scollard). These than will enter the traumatised area: the endoneurium, containing these blood vessels. The macrophages will die or change, take up more material and will expose Schwann cells to their antigenic material ao LAM, PGL1 and bacilli. It is difficult for them to leave the endoneurium, for the endoneurium has no lymph vessels while the perineurium is not permeable.

 

The bacilli may have started to multiply inside the macrophage or not. In 80% of the infected people they may not, because the macrophage either destroys the bacilli or deprives them from the nutrients and enzymes which they need to survive. Then the bacilli, if still alive, or at least their antigens particularly LAM, come in contact with the Schwann cell lying around or in contact with axons. The bacilli may enter the Schwann cell the way Rambukana proposed and may just stay as persisters, multiply or disintegrate. LAM may come in contact with the Schwann cell and activates the complement system as proposed by El Idrissi and Das. This may cause a little inflammation but most importantly it will lead to formation of MAC which will make “holes” in the Schwann cell and whereas the Schwann cell will disintegrate, the demyelisation will be a fact. The hall mark of leprosy: segmental demyelination.

 

The demyelisation may be minute, even not detectable with the methods used. This may be the case in contacts. But it may as well continue and give further demyelination in particular in MB patients (by now they have become patients since the nerve damage may become detectable). In PB patients a CMI against M.leprae antigenic determinants develops with granuloma which may destroy perineurium and endoneurium and even may cause abscesses.

 

In course of time reactions T1R and T2R may happen. T1R in Borderline patients and T2R in Borderline and lepromatous patents.

 

In T1R the CMI gives rise to oedema. Since the perineurium is not permeable and since there are no lymph vessels in the endoneurium the pressure inside will increase. This will lead to further demyelisation and compression of the axons, which will collapse and prevent nutrients from reaching the peripheral part of the axon. In due time the distal part of the axon will die. This can beautifully be shown by Nerve Conduction Studies as have been done by Garbino who found a decreasing conduction speed and a smaller surface of the compound action potential during T1R, a reaction which may take many months to resolve and leaves a lot of damage.

 

In T2R there is an inflammation due to immune complex formation and consequently complement activation. These reactions last for about one week till one month (as written by De Souza Arauyo already in 1929). These will lead to severe compression on the axons in the endoneurium and even to a conduction block (Garbino). Since the reaction is relatively short it will not do much damage, but will cause problems when it happens too often.

 

Occasionally, when the reaction has abated the pressure in the nerves remains high. This could be due to the fact that arterioles and venules obliquely pass through the often thickened perineurium. They are then being compressed due to the endoneural pressure. This diminishes the outflow of the venules which pressure is lower than that of the arterioles and which maintains the endoneural pressure and causes more oedema (Naafs). Further damage will be the result which may lead to anoxaemia when the inflow through the arterioles becomes less. In the end there will be only a near fibrosed nerve left. Still there may be reactions and demyelisation due to remnant antigens and pressure on the nerve. Neuropathic pain may persist in a further near almost useless nerve. 

 

Finally something about Lepra bonita. There is no demyelisation because most likely there is no complement activation by LAM. The Lucio phenomenon is just a blocking of the venules in the skin due to the number of bacilli which leads to infarction.

 

Ben Naafs

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LML - S Deepak, B Naafs, S Noto and P Schreuder

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(LML) InfoNTD| Information on cross-cutting issues in NTDs November 2016

Leprosy Mailing List – November 15,  2016

Ref.:  (LML) InfoNTD| Information on cross-cutting issues in NTDs November 2016

From:  Ilse Egers and Evelien Dijkkamp, Amsterdam, the Netherlands

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Dear Pieter,

 

Greetings from Infontd   In this newsletter you will find a selection of news items and recent publications on cross-cutting issues in NTDs. Each month we make a selection. Our starting point is to add articles covering a wide variety of cross-cutting issues and NTDs. Unfortunately, this is not always possible due to a publication bias and lack of articles on these issues. Feel free to contact us with any questions or to receive the full text versions if a link to the full text is not included (infontd@leprastichting.nl) . Our document delivery service is free! Kind regards,   Ilse Egers & Evelien Dijkkamp InfoNTD Information officers

 

 

News

 

 

Lymphatic filariasis and trachoma are on track for eradication; they may be eliminated in the world’s poorest countries by 2020. This is a result of a partnership of governments, charitable foundations and pharmaceutical companies. http://www.voanews.com/a/two-tropical-diseases-on-track-for-eradication-in-4-years/3549663.html News from WHO Leprosy: lessons to be learnt in overcoming discrimination and stigmatization 8 November 2016 | Seoul | New Delhi | Geneva –– The World Health Organization (WHO) has welcomed an initiative by countries to repeal antiquated laws that for centuries allowed discrimination against people affected by leprosy (Hansen’s disease). Although the disease has been eliminated as a public health problem worldwide, discrimination and stigmatization pose huge barriers to equitable treatment and social inclusion. Read more: http://www.who.int/neglected_diseases/news/Leprosy_lessons_to_be_learnt/en/

 

 

New publications

 

 

Psychological and psychosocial consequences of zoonotic cutaneous leishmaniasis among women in Tunisia: Preliminary findings from an exploratory study. Chahed MK, Bellali H, Ben Jemaa S, et al. PLoS Negl Trop Dis. 2016; 10(10):e0005090. Abstract The incidence of zoonotic cutaneous leishmaniasis (ZCL) makes it the most widespread parasitic disease in Tunisia and the Arab world. The purpose of this study was to examine the psychosocial impact of ZCL scars among Tunisian women. The results showed that anticipation of rejection and avoidance of stress are strongly correlated with a negative perception of ZCL. This makes it vital to strengthen preventive health education. Download PDF Community-based detection of post Kala-azar dermal leishmaniasis (PKDL) and its risk-factors in an endemic region of Bihar, India. Scott J, Rabi Das VN, Siddiqui NA. J Trop Dis. 2016; 4(4). Abstract A large-scale survey-based study of PKDL prevalence was conducted in the endemic region of Araria in Bihar, India. The results of the study indicate a sample prevalence of as high as 7.9 cases per 10,000 individuals. Our results suggest that factors of caste, cattle shed proximity, and gender all contribute to the characterization of the PKDL-afflicted population. Consideration of these factors can provide a clear starting point for further in-depth examination of their contribution to PKDL patterns. Download PDF Diagnosis delay and duration of hospitalisation of patients with Buruli ulcer in Nigeria. Meka AO, Chukwu JN, Nwafor CC, et al. Trans. R. Soc. Trop. Med. Hyg. 2016; 110:502-509. Abstract Delayed diagnosis of Buruli ulcer can worsen clinical presentation of the disease, prolong duration of management, and impose avoidable additional costs on patients and health providers. We investigated the profile, delays in diagnosis, duration of hospitalisation, and associated factors among patients with Buruli ulcer in Nigeria. Patients with Buruli ulcer have very long time delays to diagnosis and long hospitalisation during treatment. This calls for early case-finding and improved access to Buruli ulcer services in Nigeria. Download PDF Progress of trachoma mapping in mainland Tanzania: Results of baseline surveys from 2012 to 2014. Mwingira UJ, Kabona G, Kamugisha M, et al. Ophthalmic Epidemiol. 2016:1-8. Abstract Only three districts qualified for mass drug administration with azithromycin. Trichiasis is still a public health problem in many districts, thus community-based trichiasis surgery should be considered to prevent blindness due to trachoma. Download PDF Integrated healthcare delivery: A qualitative research approach to identifying and harmonizing perspectives of integrated neglected tropical disease programs. Means AR, Jacobson J, Mosher AW et al. PLoS Negl Trop Dis. 2016; 10(10):0005085. Abstract Qualitative data suggest several structural, process, and technical opportunities that could be addressed to promote more effective and efficient integrated NTD elimination programs. We highlight a set of ten recommendations that may address stakeholder concerns and perceptions regarding these key opportunities. Download PDF Can lymphatic filariasis be eliminated by 2020? Rebollo MP, Bockarie MJ. Trends Parasitol. 2016; S1471-4922(16):30165-9. Abstract In this Opinion article we review the prospects for achieving LF elimination by 2020 in the light of the renewed global action against NTDs and the global efforts to achieve the sustainable development goals (SDGs) by 2030. We conclude that LF can be eliminated by 2020 using cross-sectoral and integrated approaches because of the compound effect of the other SDG activities related to poverty reduction and water and sanitation.ported functional limitations in Cameroon and India. Read abstract Epidemiology of soil-transmitted helminth infections in Timor-Leste. Campbell SJ. The Australian National University. 2016:365p. Thesis. Abstract This thesis explores: what is the prevalence of STH, and what WASH risk factors contribute towards infections? What are the associations between STH infections and plausible STH-related health outcomes, and finally, what are the associations between aspects of WASH and the village environment with intensity of STH infection, in these communities? Environmental variables, but again few WASH variables, were associated with intensity of STH infection in this analysis. Despite this, WASH is the only identified mechanism that could reduce or prevent transmission in this high-transmission environment. It should be included in integrated control strategies. Download PDF Getting a GRiPP on everyday schistosomiasis: experience from Zimbabwe. Mutapi F. Parasitology. 2016:1-9. Abstract This paper considers the contributions to global schistosome control efforts made by research conducted in Zimbabwe and the historical context and developments leading to the national schistosomiasis control programme in Zimbabwe giving an example of Getting Research into Policy and Practice. Read abstract Knowledge, practices and perceptions of trachoma and its control among communities of Narok County, Kenya. Njomo DW, Karimurio J, Odhiambo GO, et al. Trop Dis Travel Med Vaccines. 2016; 2(13). Abstract Poor practices and related socio-cultural perceptions are important risk factors in sustaining trachoma infection and transmission. Community members require health education for behavior change and awareness creation about surgery, MDA and its potential side effects for elimination of trachoma in Narok County, Kenya. Download PDF Influence of socioeconomic aspects on lymphatic filariasis: A case-control study in Andhra Pradesh, India. Mutheneni SR, Upadhyayula SM, Kumaraswamy S, et al. J Vector Borne Dis. 2016; 53(3):272-8. Abstract The cross sectional study showed that the population with low and medium socioeconomic status are at higher risk of filariasis. Read abstract Onchocerciasis elimination from Africa: One step in Northern Sudan. Kazura JW. Journal Am. J. Trop. Med. Hyg. 2016; 95(5):983-984. Abstract Onchocerciasis elimination strategies and “on the ground” programs should not be viewed as static or inflexible with respect to changes in MDA policy or local ecology that could affect transmission and its resilience to various interventions. Download PDF Women's empowerment and global health: A twenty-first century agenda.   Dworkin S, Gandhi M, Passano P. Univ of California Press. 2016; 352p. Book. Abstract What is women’s empowerment, and how and why does it matter for women’s health? Despite the rise of a human rights–based approach to women’s health and increasing awareness of the synergies between women’s health and empowerment, a lack of consensus remains as to how to measure empowerment and successfully intervene in ways that improve health. Women’s Empowerment and Global Health presents thirteen multidisciplinary case studies that demonstrate how science and advocacy can be creatively merged to enhance the agency and status of women. Download PDF Controlling neglected tropical diseases (NTDs) in Haiti: Implementation strategies and evidence of their success. Lemoine JF, Desormeaux AM, Monestime F, et al. PLoS Negl Trop Dis. 2016; 10(10):e0004954. Abstract By 2012, Haiti's neglected tropical disease (NTD) program had reached full national scale. Essential to this success have been in the detail of how MDAs were implemented. Key programmatic elements included ensuring strong community awareness through an evidence-based, multi-channel communication and education campaign; strengthening community trust of the drug distributors; enforcing a "directly observed treatment" strategy; providing easy access to treatment; and ensuring quality data collection that was used to guide and inform MDA strategies. Download PDF Epidemiology of urinary schistosomiasis and knowledge of health personnel in rural communities of South-Western Nigeria. Awosolu OB. Journal of Parasitology and Vector Biology. 2016; 8(10):99-106. Abstract The high prevalence and intensity of Schistosoma haematobium infection in the current study area clearly indicated that this infection remains unabated and as such, local health personnel should be adequately trained on handling urinary schistosomiasis cases in these communities. Download PDF Promoting oral health in Africa: Prevention and control of oral diseases and noma as part of essential noncommunicable disease interventions. World Health Organization. Geneva. 2016. Manual. This manual aims at the prevention of oral diseases and promotion of good oral health. It emphasizes the fact that improving oral health is an integral part of the essential package of interventions against noncommunicable diseases at the primary health care level. Promoting Oral Health in Africa proposes a Basic Package of Oral Care, and includes a set of 10 protocols written specially for primary health care staff to aid in diagnosing and treating specific oral diseases. It also presents the overall rationale for health initiatives within school and community settings, and recommends a set of integrated activities at both levels. Download PDF Clinical research on neglected tropical diseases: challenges and solutions. Boelaert M. PLOS Neglected Tropical Diseases. 2016; 10(11):e0004853. Abstract Research pertaining to the neglected tropical diseases (NTDs) poses specific challenges that are linked to the diseases investigated, infrastructure (or lack thereof), culture, social-ecological systems, conflicting health policies, and ethics requirements, among otherr. Download PDF Improving coverage and compliance in mass drug administration for the elimination of LF in two ‘endgame’ districts in Indonesia using micronarrative surveys. Krentel A, Damayanti R, Titaley CR, et al. PLOS Neglected Tropical Diseases. 2016; 10(11):e0005027. Abstract Micronarrative surveys were shown to be a valid and effective tool to detect operational issues within MDA programs. District health staff felt ownership of the results, implementing feasible changes to their programs that resulted in significant improvements to coverage and compliance in the subsequent MDA. This kind of implementation research using a micronarrative survey tool could benefit underperforming MDA programs as well as other disease control programs where a deeper understanding is needed to improve healthcare delivery. Download PDF Disability Strengthening health information systems for disability-related rehabilitation in LMICs. McPherson A, Durham J, Richards N, et al. Health Policy and Planning. 2016:1-11. Abstract Effective health related disability planning requires reliable data on disability prevalence, functional status, access to rehabilitation services and functional outcomes of rehabilitation. For low-resource settings, and where routine HIS are already challenged, planning to include disability and rehabilitation foci starting with a minimum dataset on functioning, and progressively improving the system for increased utility and harmonization, is likely to be most effective and minimize the potential for overburdening fragile systems. Download PDF Measuring functional and patient-reported outcomes after treatment of mutilating hand injuries: A global health approach. Giladi AM, Ranganathan K, Chung KC. Hand Clin. 2016; 32(4):465-475. Abstract This article discusses these social and medical system issues and reviews components of a comprehensive approach to measuring outcomes after these injuries. Patient-reported outcomes are highlighted. Methods of optimizing outcomes measurements and studies, disability assessments, and associated research are also discussed. Read abstract Physically disabled women and sexual identity: a PhotoVoice study. Payne DA, Hickey H, Nelson A, et al. Disability & Society. 2016; 31(8):1030-1049. Abstract The study aimed to explore four young physically disabled women’s experiences and perspectives regarding sexuality and disability. We used PhotoVoice, a participatory action research method which uses photographs, to capture and convey our participants’ concerns. Through their photographs they showed that everyday interactions with others, particularly strangers or meeting people for the first time, were made difficult by how they were always seen as having a disability. Other parts of their identity were not recognised. The change the young women wanted was for people to see them as young women and not just as disabled. Download PDF Factsheet: Disability and health. Reviewed November 2016. World Health Organization WASH Status of sanitation and hygiene practices in the context of "Swachh Bharat Abhiyan" in two districts of India. Swain P, Pathela S. Int J Community Med Public Health. 2016; 3(11):3140-3146. Abstract Study finding shows that 76% of total respondent were not aware about the “Swachh Bharat Abhiyan” and 56% were not aware about the significance of keeping good sanitary conditions. It was also observed that among the total respondents only 54% were defecating in the toilet and 8% of respondents don’t wash their hands after defecation and 11% of the respondents never wash their hands before meals. As observed, only 33% of female respondents were using sanitary pads during their menstruation. Download PDF 'If an eye is washed properly, it means it would see clearly': A mixed methods study of face washing knowledge, attitudes, and behaviors in rural Ethiopia. Aiemjoy K, Stoller NE, Gebresillasie S, et al. PLoS Negl Trop Dis. 2016; 10(10):e0005099. Abstract Interventions aiming to improve facial cleanliness for trachoma prevention should focus on habit formation (to address forgetfulness) and address barriers to the use of soap, such as reducing cost. Interventions that focus solely on improving knowledge may not be effective for changing face-washing behaviors. Download PDF Assessing the impact of sanitation on indicators of fecal exposure along principal transmission pathways: A systematic review. Sclar GD, Penakalapati G, Amato HK, et al. Journal International Journal of Hygiene and Environmental Health.2016; 219(8):709-723. Abstract The studies found little to no effect from sanitation interventions on these transmission pathways. There was no evidence of effects on water quality (source or household), hand or sentinel toy contamination, food contamination, or contamination of surfaces or soil. There is some evidence that sanitation was associated with reductions in flies and a small effect on observations of feces. Studies show an inverse relationship between the distance of a water supply from a latrine and level of fecal contamination of such water supply. Read abstract

 

 

Events

 

 

COR-NTD 2016 The annual meeting for the Coalition for Operational Research on Neglected Tropical Diseases (COR-NTD) will take place on November 10-11, prior to the American Society of Tropical Medicine and Hygiene (ASTMH) Meeting in Atlanta, Georgia, USA.  The goal of the COR-NTD meeting is to strengthen the community of researchers, program implementers and their supporters to address knowledge gaps in a coordinated way, thus informing the agenda of future research and facilitating the global efforts of the World Health Organization and endemic countries to overcome NTDs. 65th Annual ASTMH Meeting November 13-17, Atlanta The American Society of Tropical Medicine & Hygiene The ASTMH Annual Meeting draws tropical medicine and global health professionals representing academia, government, non-profits, philanthropy, NGOs, industry, military and private practice. The meeting is designed for researchers, professors, government and public health officials, military personnel, travel clinic physicians, practicing physicians in tropical medicine, students and all health care providers working in the fields of tropical medicine, hygiene and global health. The Annual Meeting is a five-day educational conference, that includes four pre-meeting courses, and draws approximately 4,400 attendees. All Roads Lead to Rome: the Path to the Vatican Conference on NTDs. The Pontifical Council for Health Care Workers is hosting an International Conference on neglected tropical diseases (NTDs) and rare diseases November 10-12, 2016 at the Vatican, “Towards a Culture of Health that is Welcoming and Supportive at the Service of People with Rare and Neglected Pathologies.” Sabin President Dr. Peter Hotez will deliver the opening keynote on NTDs, an patient with the NTD lymphatic filariasis (elephantiasis) has been invited to offer a reflection and the event will end with an audience of more than 5,000 conference participants, patients, and family members with Pope Francis in Paul VI Hall. Uniting four countries in the fight against NTDs Health experts, including Lazenya Weekes from SCI, attended an MRU Health meeting to discuss how best to tackle NTDs across four countries. The Mano River Union (MRU), is an international association between Liberia, Sierra Leone, Guinea and Côte d'Ivoire. This year’s meeting between 19-21 October was the first in 3 years, due to the Ebola outbreak in the sub-region. It aimed to reinvigorate efforts against NTDs, and share ideas and experiences in the field.

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